Document Detail

Antenatal perspective of hypoplastic left heart syndrome: 5 years on.
MedLine Citation:
PMID:  18006564     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Palliative staged reconstructive surgery has radically altered the outcome of babies with hypoplastic left heart syndrome (HLHS). AIM: To compare the current outcome of antenatally diagnosed HLHS with a series 5 years previously now that paediatric cardiothoracic and postnatal paediatric intensive care techniques have been further refined. METHOD: Comparison of all cases of HLHS diagnosed antenatally at Birmingham Women's Hospital between 1 January 2000 and 31 December 2004 with results of the previous series. RESULTS: 79 fetuses were identified with HLHS. The median gestational age at diagnosis was 22 weeks. After counselling, 20 (25.3%) couples terminated the pregnancy compared with 43.7% in the previous cohort (p = 0.01). Of the 59 couples who continued with the pregnancy, four had stillbirths and two were lost to follow-up. Subsequently, there were 53 live births, of which six babies had an alternative major congenital heart disease diagnosed postnatally; 10 babies were not considered for surgery (parents' wishes) and died after compassionate care; 31 babies underwent surgery. The early (30 days) surgical mortality after stage 1 Norwood procedure was 19.4% and 20 patients are still alive. In the cohort of intention-to-treat cases, the overall survival was 46.9% (23/49). CONCLUSION: The number of parents choosing termination after an antenatal diagnosis of HLHS has almost halved since 5 years ago. Despite the significant increase in surgical survival following stage 1 Norwood in this period, in the intention-to-treat cohort the survival was 46.9%. These data again highlight the poorer outcome for babies with congenital malformations diagnosed in utero in comparison with those identified postnatally.
S V Rasiah; A K Ewer; P Miller; J G Wright; D J Barron; W J Brawn; M D Kilby
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Publication Detail:
Type:  Journal Article     Date:  2007-06-29
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  93     ISSN:  1468-2052     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-22     Completed Date:  2008-05-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  England    
Other Details:
Languages:  eng     Pagination:  F192-7     Citation Subset:  AIM; IM    
Department of Neonatology, Birmingham Women's Hospital NHS Trust, Edgbaston, Birmingham B15 2TG, UK.
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MeSH Terms
Abortion, Eugenic / utilization*
Fetal Diseases / diagnosis,  mortality,  therapy
Hypoplastic Left Heart Syndrome / diagnosis,  mortality*,  surgery*
Pregnancy Outcome
Prenatal Diagnosis
Survival Analysis
Treatment Outcome

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